Provider Demographics
NPI:1245380690
Name:FOSS, CHARLENE (LICSW)
Entity type:Individual
Prefix:MRS
First Name:CHARLENE
Middle Name:
Last Name:FOSS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 LINDEN ST
Mailing Address - Street 2:SUITE 208 A
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02482-7900
Mailing Address - Country:US
Mailing Address - Phone:508-962-1386
Mailing Address - Fax:508-620-2072
Practice Address - Street 1:148 LINDEN ST
Practice Address - Street 2:SUITE 208 A
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02482-7900
Practice Address - Country:US
Practice Address - Phone:508-962-1386
Practice Address - Fax:508-620-2472
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2135451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical